Contra Costa Regional Medical Center Fetal Monitoring Recommendations
CCRMC Antepartum Testing Phone #925-370-5609
Updated October 2009
These are recommendations and not the absolute rule--a consultant may recommend more or less monitoring in a particular case. Please be careful that your patients are not being scheduled early for testing as the schedules are very full. Sometimes if you order monitoring to begin in two weeks, nurses do not understand that sooner is not indicated so they take the first available appointment even if it is 2 weeks before monitoring is actually needed.
DIAGNOSIS
MONITORING
RECOMMENDATIONS
DECREASED FETAL MOVEMENT
Immediately at diagnosis
NST/optional AFI x 1
Consider kick count counseling for all patients
in 3rd trimester and especially high risk
POSTDATES
Low risk patient
Biweekly NST/Weekly AFI
Begin early 41st week
Usually induce by 42 weeks
Induce early 41st week for certain dates and favorable cervix
Delay induction if uncertain dates, VTOL, or unfavorable cervix
GDMA1
Adequate control on diet only
Biweekly NST/Weekly AFI
Begin by early 41st week. May begin 40-41 weeks.
Induce at 41 weeks
GDMA2
(Medication Indicated—on meds or poor control on diet)
Biweekly NST/Weekly AFI
Begin 32 weeks. Consider delay to 34-35 weeks if good control on low dose medication.
Deliver by 40 week EGA (after 39 weeks)
Consider 38 week sono for EFW if clinically suspected macrosomia. Offer cesarean if EFW>4500 gm. Consult >4200 gm.
SEVERE DIABETES
(vasculopathy, etc)
May begin as early as 28 weeks. Consult.
FETAL SIZE LESS THAN DATES
(possible IUGR)
Biweekly NST/Weekly AFI
Begin at diagnosis or pending formal ultrasound for EFW
Continue monitoring if EFW < 15th percentile by Hadlock chart. Stop if >15th percentile
Consult for delivery plan EFW < 10th percentile
CHRONIC HYPERTENSION BP>140/90
or on BP medication
Biweekly NST/Weekly AFI
Begin 32 weeks. Consider delay to 36 weeks if mild or good control and normal fetal growth
Deliver by 40 weeks. Consult for earlier delivery if severe.
Monitor closely for superimposed preeclampsia and fetal growth
GESTATIONAL HYPERTENSION OR MILD PREECLAMPSIA
After initial evaluation usually done on Perinatal Unit, begin biweekly NST/weekly AFI.
Mild Preeclampsia deliver by 38 weeks
Gestational Hypertension usually deliver by 40 weeks
MATERNAL AGE >35
Biweekly NST/Weekly AFI
Begin in the 37th week
*new recommendation
CHOLESTASIS OF PREGNANCY
Biweekly NST/weekly AFI
Begin at diagnosis or pending diagnosis after 32 weeks
Check LFTs and serum bile acids
Treat with Actigall 300mg bid-tid
Induce at 37 weeks
HISTORY OF PRIOR FETAL DEMISE
Biweekly NST/weekly AFI
Begin 2 weeks before prior demise after 28 weeks
Consider induction after 39 weeks
TWIN GESTATION
Biweekly NST
Begin 34-36 weeks for concordant dichorionic twins
Begin 32 weeks for monochorionic or discordant
Deliver by 38-39 weeks, or earlier if discordant
(>20% difference EFW)
Consider umbilical artery dopplers if one or both <10th percentile
Transfer monoamniotic to Perinatology
POLYHYDRAMNIOS AFI > 24
Biweekly NST
Begin at 32 weeks or diagnosis
Consider level II ultrasound for anomaly
Confirm no GDM
OLIGOHYDRAMNIOS
Consult. Immediate Fetal Monitoring/AFI if over 24 weeks.
Evaluate for SROM; consider anomaly such as absent kidneys if no prior sono with normal AFI.
OTHER
Thrombophilia
Renal Disease
Hyperthyroidism
Lupus
Anemia Hb < 8
Active Substance Abuse
Elevated AFP on State Screen
Two vessel umbilical cord
Other significant maternal medical condition
Biweekly NST/weekly AFI
Begin at 32 weeks or when identified after 32 weeks
Contra Costa Regional Medical Center Fetal Monitoring Recommendations
CCRMC Antepartum Testing Phone #925-370-5609Updated October 2009
These are recommendations and not the absolute rule--a consultant may recommend more or less monitoring in a particular case. Please be careful that your patients are not being scheduled early for testing as the schedules are very full. Sometimes if you order monitoring to begin in two weeks, nurses do not understand that sooner is not indicated so they take the first available appointment even if it is 2 weeks before monitoring is actually needed.
MOVEMENT
NST/optional AFI x 1
in 3rd trimester and especially high risk
Low risk patient
Begin early 41st week
Induce early 41st week for certain dates and favorable cervix
Delay induction if uncertain dates, VTOL, or unfavorable cervix
Adequate control on diet only
Begin by early 41st week. May begin 40-41 weeks.
(Medication Indicated—on meds or poor control on diet)
Begin 32 weeks. Consider delay to 34-35 weeks if good control on low dose medication.
Consider 38 week sono for EFW if clinically suspected macrosomia. Offer cesarean if EFW>4500 gm. Consult >4200 gm.
(vasculopathy, etc)
THAN DATES
(possible IUGR)
Begin at diagnosis or pending formal ultrasound for EFW
Consult for delivery plan EFW < 10th percentile
HYPERTENSION BP>140/90
or on BP medication
Begin 32 weeks. Consider delay to 36 weeks if mild or good control and normal fetal growth
Monitor closely for superimposed preeclampsia and fetal growth
Gestational Hypertension usually deliver by 40 weeks
Begin in the 37th week
Begin at diagnosis or pending diagnosis after 32 weeks
Treat with Actigall 300mg bid-tid
Induce at 37 weeks
FETAL DEMISE
Begin 2 weeks before prior demise after 28 weeks
Begin 34-36 weeks for concordant dichorionic twins
Begin 32 weeks for monochorionic or discordant
(>20% difference EFW)
Consider umbilical artery dopplers if one or both <10th percentile
Transfer monoamniotic to Perinatology
AFI > 24
Begin at 32 weeks or diagnosis
Confirm no GDM
Thrombophilia
Renal Disease
Hyperthyroidism
Lupus
Anemia Hb < 8
Active Substance Abuse
Elevated AFP on State Screen
Two vessel umbilical cord
Other significant maternal medical condition
Begin at 32 weeks or when identified after 32 weeks